Efficacy and Safety of Topical Silymarin Versus Low Fluence 1064-nm Q Switched Nd:YAG Laser in the Treatment of Melasma: A Comparative Randomized Trial.

BACKGROUND AND OBJECTIVES: The management of melasma is challenging and requires multiple uses of available therapeutic options. To compare the short-term efficacy and safety of topical silymarin and low fluence 1064-nm Q-switched ND:YAG laser for treatment of melasma with dermoscopic follow-up. STUDY DESIGN/MATERIALS AND METHODS: Fifty female patients with melasma were included in this study. They were randomly divided into two groups. Group A: 25 patients were treated with six sessions of low fluence Q switched ND:YAG 1064-nm laser, and group B: 25 patients were treated with topical silymarin cream 1.4% with a 3-month treatment duration. Patients were evaluated clinically by the modified melasma area and severity index (mMASI) score. Dermoscopic examinations were performed before and after the treatment sessions. RESULTS: The severity of melasma, as evaluated dermoscopically and clinically by mMASI score, was significantly reduced after treatment in all patients with no recorded side effects. There was no statistically significant difference between both studied groups regarding the change in mMASI score and dermoscopic assessment of the patients after the treatment sessions. CONCLUSION: Both low fluence Q switched ND:YAG 1064-nm laser and topical silymarin cream appear to be safe and effective modalities in the treatment of melasma. © 2021 Wiley Periodicals LLC.

A comparative study between oral tranexamic acid versus oral tranexamic acid and Q-switched Nd-YAG laser in melasma treatment: a clinical and dermoscopic evaluation.

BACKGROUND: Melasma is a common acquired disorder of pigmentation. OBJECTIVE: To compare the efficacy of oral tranexamic acid (TA) versus oral TA and Q-switched Nd: YAG laser (1064-nm wavelength) in the treatment of melasma. MATERIALS AND METHODS: Sixty patients were divided into two groups. Group A: oral TA only and group B: oral TA plus Qs-Nd: YAG laser (1064 nm) sessions. Evaluations were performed on the clinical basis including the use of Modified Melasma Area and Severity Index (m MASI) and dermoscopy. Dermoscopic examinations were performed before and after the treatment sessions as well as at the 3-month follow up visit. RESULTS: There were statistically significant differences between the two studied groups regarding the change of m MASI after treatment and at the end of follow-up (p = .036) by using dermoscopy. Epidermal type of melasma showed the best response (0.048) and telangiectasias significantly improved in both groups of patients. CONCLUSIONS: Low-fluence 1064-nm Qs-Nd:Yag laser is effective and safe line of melasma treatment. Adding oral TA may enhance its clinical efficacy and decrease its side effects or complications. Dermoscopy is an important tool in pigment detection and vascular components in melasma, as well as their response to treatment.